Key parameters from PHQ-9 analysis.

This study sought to conduct a large-scale examination (N = 14,951) into the associations between therapeutic alliance and anxiety and depression symptom trajectories within a blended care therapy (BCT) program. Clients receiving blended care services completed weekly outcome measures for anxiety and depression and therapeutic alliance ratings every other therapy session. Using a retrospective, pragmatic study design, latent change score (LCS) analysis captured individual differences in initial therapeutic alliance scores and change in alliance. The LCS variables were specified as predictors of a latent growth curve model describing changes in depression and anxiety symptoms over the course of treatment. Therapeutic alliance scores in the BCT program were generally strong (initial item average = 4.10) and improved over time. Higher initial therapeutic alliance scores and greater initial increases in alliance were associated with steeper declines in anxiety and depressive symptoms at the beginning of therapy. Higher therapeutic alliance (both initial scores and initial increases) was also associated with a deeper symptom trajectory over time, indicating lower anxiety and depressive symptoms overall, as well as sustained decreases in symptoms over time. These results highlight the clinical impact of the working relationship between the provider and the client.

本研究旨在开展一项大规模考察（样本量N=14951），探究混合护理治疗（blended care therapy，BCT）项目中治疗联盟（therapeutic alliance）与焦虑、抑郁症状轨迹之间的关联。接受混合护理服务的来访者需每周完成焦虑与抑郁症状的疗效评估，并在每两次治疗后填写治疗联盟评分。本研究采用回顾性实用研究设计，通过潜变量变化得分（latent change score，LCS）分析捕捉初始治疗联盟评分及联盟随时间变化的个体差异。将LCS变量设定为潜增长曲线模型的预测因子，该模型用于描述治疗期间焦虑与抑郁症状的动态变化。BCT项目中的治疗联盟评分整体处于较高水平（初始条目均分为4.10），且随治疗推进有所提升。更高的初始治疗联盟评分以及联盟的初始增幅更大，均与治疗初期焦虑与抑郁症状的更显著下降相关。更高的治疗联盟水平（包括初始评分与初始增幅）还与更理想的长期症状轨迹相关，具体表现为整体焦虑与抑郁症状水平更低，且症状随时间持续缓解。上述结果凸显了治疗师与来访者之间的工作关系对临床实践的重要影响。